title: Physician assistant model for lung procurements: a paradigm worth considering.
abstract: BACKGROUND
  Thoracic procurements have traditionally been performed by surgical fellows or attending cardiothoracic surgeons. Donor lung procurement protocols are well established and fairly standardized; however, specific procurement training and judgment are essential to optimizing donor utilization. Although the predicted future deficits of cardiothoracic surgeons are based on a variety of analytic models and scenarios, it appears evident that there will not be a sufficient number of trained cardiothoracic surgeons over the next 2 decades. Over the past 5 years in our institution, lung procurements have been performed by a specifically trained physician assistant; as the lead donor surgeon. This model may serve as a cost effective, reproducible, and safe alternative to using surgical fellows and attending surgeons, assuring continuity, ongoing technical expertise, and teaching while addressing future workforce issues as related to transplant.
  
  
  METHODS
  This is a single institution review of 287 consecutive lung procurements performed by either a physician assistant or fellow over 5 years. This study was approved by the Institutional Review Board of Columbia University, which waived the need for informed consent (IRB#AAAL7107).
  
  
  RESULTS
  From 2008 to 2012, fellows served as senior surgeon in 90 cases (31.4%) versus 197 cases (68.6%) by the physician assistant, including 12 Donations after Cardiac Death and 6 reoperative donors. Injury rate was significantly lower for the physician assistant compared with the resident cohort (1 of 197 [0.5%] vs 22 of 90 [24%], respectively). Rates for pulmonary graft dysfunction grade 2 and 3 were found to be significantly lower in cases where the physician assistant served as senior surgeon (combined rates of 32.2% [29 of 90] vs 9.6% [19 of 197] in the physician assistant group) (p < 0.01).
  
  
  CONCLUSIONS
  Use of experienced physician assistants in donor lung procurements is a safe and viable alternative offering continuity of technical expertise and evaluation of lung allografts.
authors.affiliation: Section of Thoracic Surgery, Columbia University Medical Center, New York, New York.
authors.forename: Joseph
authors.initials: J
authors.lastname: Costa
authors.forename: Frank
authors.initials: F
authors.lastname: D'Ovidio
authors.forename: Matthew
authors.initials: M
authors.lastname: Bacchetta
authors.forename: Matthew
authors.initials: M
authors.lastname: Lavelle
authors.forename: Gopal
authors.initials: G
authors.lastname: Singh
authors.forename: Joshua R
authors.initials: JR
authors.lastname: Sonett
mesh_terms: D000488:Allied Health Personnel / Q000193:education*; D064591:Allografts; D006085:Graft Survival; D006801:Humans; D007396:Internship and Residency; D016040:Lung Transplantation / Q000193:education*; D010823:Physician Assistants / Q000193:education*; D012189:Retrospective Studies; D009927:Tissue and Organ Procurement / Q000379:methods*; D014481:United States
keywords: 12